DEVELOPING A NEW PARADIGM FOR STUTTERING

by John C. Harrison
The National Stuttering Association
(jcharr1234@aol.com)

There's a familiar brain teaser that involves a square comprised of nine
dots made up of three rows of three dots each. Using only four straight
lines, and without taking your pen from the paper, you are challenged to
pass your pen through all nine dots.

I remember trying to solve this puzzle and my frustration at not finding
the solution. After struggling for a while, it seemed there was no way it
could be done, so I threw in the towel. But I just couldn't give up and a
while later returned to the problem.

"What am I assuming?" I asked myself. "How am I limiting myself?"

I eventually figured it out. Like most people, I had assumed that my
lines had to stay within the boundaries of the 9-dot square. Once I went
beyond that self-imposed limitation, the answer was forthcoming.

The lessons of this story have applied directly to my own recovery from
stuttering. As a person who has spent his professional life in a creative
field (my position with the NSP is not a paid one), I've learned that
whenever I struggle for a long time with a problem without making
headway, I'm usually trying to solve the wrong problem. As someone who
stuttered for 35 years and who has been fully recovered(1) for the last 20,
I am also convinced that the paradigms traditionally used to characterize
the chronic blocks of adult stuttering are not inclusive enough to fully
describe the dynamics that drive the problem.

----------------------------------------------------------------
(1) By "recovered" I don't mean that I am a controlled stutterer. I mean
that not only has my stuttering disappeared, I no longer have the emotional
responses of someone who stutters. Fear of speaking is not a consideration
in my life; in fact, I enjoy virtually any opportunity to speak, such as
talking on the telephone and addressing audiences.
-----------------------------------------------------------------

In the following pages I would like to suggest a different paradigm, one
that resonates with my evolution into a non-stutterer as well as with my 16
years experience in the National Stuttering Project.

But before we go on, a few words on my stuttering history. I was
always aware that I had a "speech problem." At the age of four and a half
I was sent for several months to the National Hospital for Speech and
Hearing Disorders in New York. I later returned for several more months
during the summer of my eighteenth year.

During my grammar and high school years and throughout college I
underwent the painful and embarrassing experiences associated with
chronic stuttering. My dysfluency took the form of a silent block and was
situational. I generally had little trouble speaking to my schoolmates, but if
I had to recite in class, stop a stranger on the street or speak to an authority
figure I would lock up. The fact that I didn't stutter in all situations made
these dysfluent episodes all the more painful, since I inhabited that nether
world of being neither normal nor abnormal.

Aside from the two brief episodes at the National Hospital, however, I
had no formal speech therapy. I say "formal therapy" because I did spend
many hours in my mid-20's carefully observing what I did when I
stuttered, and over time, systematically brought into awareness the muscles
and other behaviors involved in my speech blocks. I also moved to San
Francisco and immersed myself in a plethora of personal growth programs
that were just then being introduced in California.

HOW MY STUTTERING DISAPPEARED

People frequently ask me, "When did you stop stuttering?"

I usually answer, "I stopped stuttering a long time before I stopped
stuttering." This is not meant as a cryptic response, but simply to point out
how the transformation took place.

Through the hundreds of hours that I participated in therapeutic and
other group activities, I discovered that my "speech problem" was actually
a constellation of problems. True, I did things with my lips, tongue, vocal
cords and chest that were counterproductive to fluent speech, but that
wasn't the only thing amiss. I lacked self-assertiveness. I was overly
perfectionistic. I was concerned with pleasing others. I saw life as a
performance. I didn't share what I felt. I didn't even know what I felt. I
believed things about myself that weren't true, and blocked out things that
were.

The deeper I delved into myself during these years of exploration, the
more I was struck by how my various problems were not only interrelated,
but dynamically present in my speech each time I blocked. It was as if each
speech block, like a corner of a hologram, contained a complete view of
my total self. It was during this period of self-discovery that my stuttering
"disappeared"; not the behaviors, of course, which took longer to tail off,
but my perception of what was really going on. I no longer identified what
I was doing as "stuttering."

What makes stuttering such a contrary problem and so resistant to
treatment is the limited way in which it is traditionally perceived.
Stuttering is generally regarded as a speech problem. But stuttering can be
more accurately understood as a system involving the entire person--an
interactive system that's comprised of at least six essential components:
behaviors emotions, perceptions, beliefs, intentions and physiological
responses. This system can be visualized as a six-sided figure--in effect, a
Stuttering Hexagon--with each point of the Hexagon connected to and
affecting all the other points. It is the moment-by-moment dynamic
interaction of these six components that maintains the system's homeostatic
balance.

It is precisely because of the self-perpetuating nature of the system that
it is so difficult to bring about permanent change at only one point. What
usually happens is that after therapy most people who stutter slide back.
This is because many therapy programs simply adopt a strategy of control
in which only speech issues are addressed. Nothing is done to transform
the system that supports the dysfluent speech. A strategy of disappearance,
on the other hand, calls for breaking down the stuttering system into its
separate components and making changes concurrently at other points
around the Stuttering Hexagon--specifically addressing the individual's
emotions, perceptions, beliefs and programming. Pursuing this global
strategy can lead to a self-maintaining fluency system because not only are
the speech blocks addressed but also those contributing factors which lead
the person to block. It can also lead to a different perception of what
stuttering is all about.

BUILDING A SYSTEM MENTALITY

To understand how a different system paradigm can change your
perception, consider this analogy. Let's say you're about to demonstrate to
two interested spectators the operation of a new remote controlled car--the
kind you can buy at Radio Shack for under $50. One spectator is a 2-year-
old boy. The other is a mechanical engineer.

The 2-year-old sees the car as a single living object. It seemingly has a
will of its own, at one moment darting forward, then stopping, turning,
exploring; a capricious little life form. The engineer, on the other hand,
has a totally different experience. He sees the car, not as a thing, but as a
system comprised of interacting parts. He inspects the motor, examines the
electronics, perhaps even looks over the schematic. He develops an
understanding of the parts and how they interrelate.

This analogy is not dissimilar from the differences between how I used
to see stuttering and how I see it today. As a teenager, I experienced
stuttering as a thing, a life form whose behavior I could not predict from
day to day. Today, having "popped the hood" and looked inside, I
understand that this "thing" I called stuttering is actually a collection of
components in a particular kind of relationship.

But hold on. We have a problem, because at this moment you don't
know for sure what I mean by "stuttering." Am I talking about the kind of
stumbling that 8-year-old Johnny does when you surprise him with his
hand in the cookie jar? Or am I talking about Johnny's struggle to say his
name when I introduce him to you. How can we continue this discussion
when we may not even be talking about the same problem?

To aid in this process, there's something we first need to do: we need to
replace the word "stuttering." In a letter to the editor in the "Journal of
Fluency Disorders" ("How to Rid Yourself of Stuttering in under 60
Seconds." John C. Harrison, J. Fluency Disord., 16 (1991) 327-333) I
argued how the word "stuttering" promotes confusion by being too vague
and unspecific. I observed that the easy disfluencies that many people
experience in emotional situations are manifestly different from the
struggle behavior characteristic of a full-fledged stuttering block. One is a
reflex triggered by emotions and probably influenced by genetic factors.
The other is a learned strategy, a set of behaviors designed to break
through or wait out a speech block. They are, in short, not simply points
on a continuum but entirely different phenomena. By using a common
name, we imply relationships and similarities that may not in fact exist, and
it only creates endless confusion to call them by the same name--
"stuttering"--even if we distinguish one as "primary" and the other as
"secondary."

For this reason, I propose that we give up the word "stuttering" (except
in the broadest of discussions) and differentiate each of five different
behaviors by assigning to it its own separate and unique terminology.

-- The disfluencies that surface as the young child struggles to master
the intricacies of speech we'll call DEVELOPMENTAL DYSFLUENCY.
This has a developmental model all its own which is separate and distinct
from the developmental model of adult blocking behavior. Developmental
disfluency often disappears on its own as the child matures. It is also
highly receptive to therapeutic intervention, so much so that when treated
early enough, most children attain normal speech without any need to
exercise controls. (Note: Both pathological dysfluency and developmental
disfluency are subjects that will not be addressed in this paper, since we are
limiting our discussion to chronic blocking.)

-- For the easy and unselfconscious disfluency characteristic of those
who are temporarily upset or discombobulated we'll need to make up a
word, since one does not exist. We'll call this kind of disfluency
BOBULATING. Almost everyone bobulates under certain stressful
conditions. However, this is usually not a chronic problem, and even if it
were, the person is generally unaware of his behavior and is, therefore,
unlikely to have negative feelings toward it.

-- The struggled, choked speech block that comes about when someone
obstructs his air flow and constricts his muscles we'll call BLOCKING
because the person is blocking something from his awareness (such
uncomfortable emotions or self-perceptions) or blocking something from
happening that may have negative repercussions. This is the chronic
disfluency that most people think of when they speak of "stuttering"
behavior that extends into adulthood. Unlike developmental disfluency and
bobulating, blocking is a strategy designed to protect the speaker from
unpleasant consequences.

-- Finally, there is a fifth kind of dysfluency related to blocking that
occurs when the person continues to repeat a word or syllable because he
has a fear that he will block on the following word or syllable. Since he is
just buying time until he feels ready to say the feared word, we'll call this
kind of dysfluency STALLING. Because stalling is an alternate strategy to
the overt struggle behavior associated with speech blocks, the two must be
considered in the same vein.

I know that many readers will bridle at the thought of not using
"stuttering" as common currency in all situations. But since developmental
disfluency, bobulating, blocking and stalling can look identical to the
untrained eye (and, unfortunately, to some trained eyes as well), calling
them all "stuttering" can substantially help to obfuscate the problem (2) (3).

---------------------------------------------------
(2) I'm not the first to feel that the word "stuttering" has vast deficiencies
as an accurate descriptor. An article in the Journal of Fluency Disorders in
December 1989 by R.M. Boehmler and S.I. Boehmler addresses this same
issue:

From the synoposis: "There is a consensus among speech-language
pathologists that the
cause of stuttering is unknown. This lack of understanding is not due to the
lack of research effort, but it may be due to asking an unanswerable
question. We may already know the causes of many of those behaviors that
make up the general concept, stuttering, if we would ask more specific
questions."

The article goes on to say that, "The term stuttering is used to refer to a
wide variety of behaviors, feelings, or phenomena. The term is used as a
label for an abstract concept. Use of such abstract terms in research
questions may make the question unanswerable by the standards of
scientific methodology. One cannot get concrete, scientific answers to
abstract, vague questions. Instead of asking, 'What causes stuttering,' it
might be more productive to separate questions about dysfluencies from
questions about blocks.... We might instead ask, 'What causes elemental
repetitions?' or 'What causes blocks?' It has been clinically productive to
go further and formulate causal hypotheses about specific types of blocks
and subcategories of traditional dysfluency types. A...glottal block, does
not necessarily have the same cause as ...a lingual block. Not all elemental
repetitions would logically have the same etiology.

..."Directing our causal hypotheses around the collective group of
behaviors we call 'stuttering' has not proven to be fruitful. Liebetrau et al.
(1981) point out 'stuttering is not a unitary disorder, but rather a generic
label for a wide range of related disorders.' ...Our research efforts may be
more productive and our intervention more effective if we focus on very
specific behaviors rather than on a collection of related behaviors.

"It is our belief that the 'cause' of 'stuttering' is knowable, and perhaps
already known to a great extent, using current data, if the question is asked
in an answerable form." The Cause of Stuttering: What's the Question?
R.M. Boehmler and S. I. Boehmler, J. Fluency Disord., 14 (1989), 447-
450.

(3) Dr. Eugene B. Cooper also shares these same sentiments. In an
interview printed in The Clinical Connection, Vol. 4, No. 1, pp. 1-4, he
opines that "with our increased understanding of the complexity of fluency
disorders, the term stuttering, like the term cancer, simply does not convey
sufficient information to be very useful in our discussions of the problem.
In fact, the continued use of the term as a definitive diagnostic label is
counter-productive. Its use as a diagnostic label suggests there is only one
type of stuttering disorder and that the disorder's single determining
characteristic is disfluent behavior when in fact clinical stuttering is
composed of affective and cognitive components as well as behavioral
components."
-------------------------------------------------------

THE COMMONALITY OF SYSTEMS

Several years ago at the National Stuttering Project's Seventh Annual
Convention in Dallas I was conducting a mini-seminar on the Stuttering
Hexagon.

"How many people have ever wrestled with a weight problem?" I asked.
As expected, more than half the people raised their hands.

I walked over to the flip chart. "As you probably know, studies indicate
that over 85% of all people who go on a diet eventually regain the weight
they've lost. So let's make a list of some of the reasons why diets don't
work. What's hard about staying on a diet?"

People began calling out their reasons. "No fun," somebody
volunteered. "I'm rebellious," called another. "Easy to procrastinate,"
somebody else said. "I go on automatic when I'm stressed," offered a
fourth. In a few minutes I had written a list of some thirty to forty reasons
why diets traditionally fail.

"Okay, watch this," I said. "We're going to do a little sleight of hand."

Up to this point I had left the chart untitled. I then wrote the title:
"Why people have problems with speech therapy."

You could have heard a pin drop as people contemplated the chart.
Remarkably, the reasons why diets by themselves are ineffective were
almost identical to why over 85% of those undergoing speech therapy lose
ground in the ensuing months.

Successfully giving up weight and successfully recovering from chronic
stuttering (blocking) are both system problems to which the hexagon
paradigm applies.

To better understand this, let us expand our analogy and develop in
parallel the ways that the Hexagon paradigm applies equally to blocking
and to losing weight.

THE SIX POINTS OF THE HEXAGON

PHYSIOLOGICAL RESPONSES. Some people have a predisposition to
being overweight. They're born with a greater concentration of cellulite, a
sluggish metabolism, a problematic thyroid. Similarly, people react
differently to stress. If a car backfires loudly, one person's autonomic
nervous system may go into overload while another's may hardly react at
all. As we know, stress can induce disfluency by interfering with an
individual's fine-motor performance. The physiological component might
be explained by personal differences in muscle latencies, neurotransmitters,
nervous system thresholds, respirator/speech-motor systems coordination,
and/or speech-motor processing, planning and execution. But whether an
individual's disfluency turns into debilitating blocks or a simple disruption
in the smooth flow of speech (bobulations) depends on many other factors.
Most discussions on whether "stuttering" is or is not genetic fail to
distinguish between the physiological responses associated with bobulating,
blocking or stalling. This leads to endless confusion because the involved
parties are not in agreement on exactly what is meant by "stuttering."

BEHAVIORS. Are certain behaviors counterproductive to losing
weight? Of course. They're described as "bringing the fork to the
mouth," "dipping into the cookie jar," "licking the ice cream cone." It's
obvious that if you could curtail the behavior, you could remove the weight
problem. Similarly, we know that there are specific behaviors--holding the
breath, pursing the lips, locking the vocal cords--that are
counterproductive to fluent speech. We also know that if the person
curtails these behaviors, fluency is possible.

EMOTIONS. If you've ever been to a party where you found yourself
uncomfortable, you probably remember how hard it was to curb your
appetite when the hors d'oeuvre tray came around. People eat when
they're anxious, another example of how emotions drive behavior. But
behavior (overeating) also leads to obesity which leads to more emotion
(self-hate, embarrassment, etc.), which leads to more eating. This closed
loop demonstrates how certain behaviors become self-perpetuating.

Similarly, in the development of chronic stuttering, early emotional
upsets can lead to bobulating. If this, in turn, leads to overcontrolled
speech and chronic blocking, then the inability to speak at the appropriate
moment will engender emotional upsets such as frustration, fear,
embarrassment, dejection, helplessness, which, in turn, can trigger more
struggle that leads to more speech blocks.

PERCEPTIONS. Our perceptions are influenced by our beliefs,
expectations and our state of mind. For example, the anorexic person may
be thin as a rail, but her perception that she's actually overweight may lead
her to starve herself. Similarly, a person who believes he's an oddity
because of how he talks will constantly project his own agenda into the
reactions of others, creating a world of stress in which blocking and
stalling behaviors flourish.

BELIEFS. Our beliefs are created by everything we're taught,
especially by those whose credibility is so high (such as our parents) that
we take what they say at face value. Beliefs are also built from our life
experiences and from what we have come to expect about the world.
Unlike perceptions, which can be easily modified by how we feel, beliefs
remain relatively constant from moment to moment. Negative beliefs, in
particular, can keep us in a one-down position and make it difficult for us
to change. We may believe that we can never be thin. We may believe that
good-looking girls (or guys) will never want to go out with us. We may
believe it's wrong to be assertive. We may believe that we're different
from other people because we stutter. Once our beliefs are formed, they
cause us to shape the world to fit our expectations. In effect, our beliefs
become windows that color the way we see and experience.

INTENTIONS. We also develop behavioral programs to help us
manage our daily encounters with life. These programs (or "games", as
psychiatrist Eric Berne labeled them), can end up working against us. For
example, if we are rebellious toward authority, we may perceive any
friendly request as a demand, which then motivates us to find subtle ways
to undermine the person's authority. If the request is for us to lose weight,
we may instead head for the refrigerator. If the request is to undergo
speech therapy, and if we are haboring hidden anger and rebellion, it may
lead us to initiate strategies that undermine the therapy and cause it to fail,
thereby proving the authority wrong (and us right!) Similarly, in a speech
block, our apparent intention may be to speak the word, while our equally
powerful hidden intention may be to hold back out of fear of revealing
ourselves, our imperfections, etc. When our intentions pull us in opposite
directions, we experience ourselves as blocked and unable to move.

A SELF-MAINTAINING SYSTEM

What makes the Hexagon able to support itself is that, functionally, **all
points interact with all other points**. This interaction is happening
moment by moment, in real time. For example, it's not just that our
beliefs that have a bearing on our perceptions. Our perceptions are also
affected by our emotions, behaviors, hidden games and even our
genetically-induced responses. Any changes made at one point are felt at
all the other points we well. This principle holds true for every point on
the Hexagon.

It's important to keep this interconnection in mind whenever we're
working to effect a change with an individual's speech. Let's say a person
undergoes a successful program of speech therapy. He (or she)5 achieves a
high level of fluency. But in the weeks and months that follow the person
does nothing to modify (1) his negative emotional responses; (2) his
negative perceptions; (3) what he negatively believes to be possible, and
that includes every belief he holds about who and what he is; and (4) the
negative psychological programming or patterned behavior that leads him
to react in self-defeating ways.

What is likely to happen?

His blocking will return (or in the case of weight, the pounds will
reappear.) This is because each of these points is continually exerting a
negative influence on the only positive point in the system (Point #2: fluent
speech), and over time the person's speech will gradually slip back into the
old familiar dysfluency. In short, the original system will re-establish
itself.

The Hexagon dynamic also explains why some people go through speech
therapy (or diets) and are able to maintain their gains. They've already
been making significant changes at the other points on the Hexagon, so the
Hexagon is structured to support a more liberated, expressive, confident
way of speaking.

MOVING TO A FUNCTIONAL LEVEL

So far in our discussion of the Stuttering Hexagon I've been describing
the system from a broad perspective. I've proposed that there are at least
six factors involved in blocking, and these are the six components of the
Stuttering Hexagon: genetics, emotions, perceptions, beliefs, behaviors and
intentions. I've suggested that each component is constantly affecting, and
being affected by, all other components. Now I'd like to demonstrate the
Hexagon on a functional level and show how it affects our speech on a
word-by-word basis....how, in fact, it creates the stuttering block itself.

I work on a Macintosh computer, and one of the programs I can't live
without is the interactive spell checker. As I type each word, the computer
compares it to the correctly spelled word stored in a dictionary deep in
RAM memory. If the word is not spelled correctly, the computer beeps.
The beep generally comes just a few hundredths of a second after I finish
typing the word. Under any circumstance, this is fast. But it's not as fast
as the human mind, as this next account will demonstrate.

One evening a dozen years ago I was listening to a new talk show host
on KCBS radio in San Francisco. The host was discussing advancement
opportunities for women when he made a Freudian slip that he caught and
corrected in the shortest instance I'd ever experienced. (This was during
the time when the women's movement was pressing forward on all fronts.)
He said something like, "When it comes to climbing the corporate ladder, I
think girls I can't believe I said that I think women deserve equal
opportunity..." and he went on with his rap.

The host had made an embarrassing faux pas. He had called women
"girls." But what was startling was how fast he corrected himself. He said
the word "girls", his ear processed the sound, his mind processed the word,
caught the slip, searched the stored memory for the appropriate word,
delivered the word to the voice mechanism which spoke the corrected
word, **all without missing a beat**. There was literally no perceived
time between the slip and the correction. His original statement and his
correction were spoken as a run-on sentence with no discernible pause.
Mind you, this fellow was not a slow talker. Like many radio
personalities, he was racing along at maybe 130 words a minute, so each
step in the process I just described had to have been measured in
milliseconds. That's how fast the mind works.

I'm suggesting that, as the person with a chronic blocking problem
approaches each word, his mind acts like the forward-looking radar on a
high performance fighter flying just a few hundred feet off the ground.
The radar looks ahead for hazards, sees a hill or tall building, sends the
information back to the aircraft where the on-board computer evaluates
this data and sends the appropriate commands to the ailerons and other
aircraft controls that cause the plane to move higher and avoid the danger.

In the case of blocking, the danger may be a feared block on a
particular word, or a feared situation in which the emotions associated with
the freely spoken word represent a danger. Because the mind is capable of
working so quickly, it has abundant time to look ahead, process each word
for safety by accessing the mind's vast memory banks, and if a threat is
perceived, plan and initiate a defensive strategy...a strategy that calls for
holding oneself back until the danger has passed.

I'm suggesting that, instead of having to blame speech blocks on some
mysterious genetic glitch or the confluence of unknown factors, we can
make sense of them with information already at hand. We can
satisfactorily explain speech blocks as an incredibly rapid series of events
in which the lightening-like processing of the mind references the
emotions, perceptions, beliefs and intentions, and as the result of the
perceived danger, executes defensive strategies on a word-by-word basis.

In short, what I'm suggesting is that the Stuttering Hexagon is both a
conceptual framework and a real-time data processing model that describes
how the mind and body work together to process experience and take
remedial action.

HOW THE HEXAGON OPERATES

To see this process in action, we'll create a scenario in which Bob, a shy
young man, is building up enough nerve to make a pass at an attractive girl
in a cocktail lounge (always an emotionally loaded situation). What he
wants to say is, "Hi, my name is Bob. I just flew in from San Francisco.
Can I buy you a drink?"

Let's step back and look at his Stuttering Hexagon. Bob perceives that
Sally, the young woman, is attractive; he is drawn to her. However, since
Bob does not perceive himself as her equal, he automatically gives her
power over him, specifically, the power to validate him. Thus, his
perceptions have a negative bias.

Because Bob tends to automatically put himself in a one-down position,
he believes that Sally will not be interested in him. She'll reject his offer.
So his beliefs also have a negative bias...even more so since experience
already leads him to believe that he will have difficulty saying his name.

But Bob is really attracted to Sally, so he persists. However, his
perceptions and beliefs have triggered a medley of negative emotions: fear
(of being rejected), hurt (anticipated, because of the rejection), and anger
(anticipated, as a reaction to being hurt). This gives his emotions a
negative bias.

Now let's move in closer and look at the words he wants to say. His
genetic make-up is such that he's quick to react under stress, and his stress
reaction is heightened as he approaches the moment when he must give his
name. Saying his name is particularly difficult because he perceives that
people expect him to say it without hesitation (after all, he should know
what his own name is without having to think), and this pumps up his fear
level.

Consequently, his adrenaline level skyrockets as his body marshals itself
for fight or flight. His heartbeat increases. His blood pressure soars.
Blood rushes away from his stomach and toward his muscles. His anal
sphincter closes. All of this is a genetically driven response to prepare for
danger. He's now in a stress reaction, ready to meet the threat. But this is
not a physical danger, as the body believes. It's a social danger. No
matter. The body doesn't perceive the difference. So here is Bob, trying
to look relaxed and casual, while his body is marshalling its defenses for
physical attack. Does all this help to build his confidence? It does not,
because his physiological response to danger is creating additional
insecurity and discomfort.

Bob has also conflicting intentions. On one hand, he wants to
communicate with Sally; on the other hand, he is afraid of letting go and
investing himself totally in the moment and perhaps be rejected. So his
hidden intentions are negative as well.

If Bob says his name assertively, he'd be acting outside his comfort
zone, reaching beyond what his self-image says is credible. Thus, as he
goes to say the word "Bob," two overpowering fears surface: (1) the fear
that he may block, and/or (2) the fear that he may come off as too
aggressive.

What does he do? He retreats into his comfort zone and holds back.

But at the same time, he also tries to speak.

If his will to speak and not speak are of equal strength, he'll find
himself blocked, unable to move in either direction. The block in turn will
generate a sense of panic which will render him "unconscious." He will lose
contact with his experience and with the other person. In desperation, he
may try to forcefully break out of the block by trying to say the word any
way he can. In so doing, he will execute a Valsalva maneuver , a strategy
identified with performing acts of strenuous physical effort. ("Stuttering
and the Valsalva Mechanism: A Hypothesis in Need of Investigation."
William D. Parry, J. Fluency Disord., 10 (1985) 317-324.) This calls for
further locking of the throat, tightening of the abdominal muscles and
building up of air pressure in the chest as he tries to push the words out.
(As an alternative strategy, he may also stall by repeating the word
"is"until he feels ready to say the word "Bob") He will continue to be
blocked until the intensity of his panic begins to drop, at which point his
muscles will begin to relax, and he will suddenly find himself able to
continue on with the sentence. As we can see, then, his habitual behaviors
are also a negative. So all the negatives reinforce each other, creating a
self-supporting, negatively biased system.

This is, of course, not the only circumstance under which Bob may
block, but hopefully, it is a convincing demonstration of how the parts of
the Hexagon work together to immobilize his ability to speak.

To recapitulate, the blocking system operates like a forward-looking
radar that anticipates problems before they happen on a situation-by-
situation and word-by-word basis. Every word has its individual Hexagon,
which can contain negatively or positively biased data. The information
contained in the Stuttering Hexagon is scanned by the mind which, like a
forward-looking radar, is constantly searching ahead for danger. If the
information in the Hexagon constitutes a threat, the word will feel
"loaded", and Bob's survival system will chart a course to avoid the danger
by holding back until the danger has passed. Thus, on bad days when his
self-esteem is low, most words may feel threatening, while on days when
he's feeling good, the same words will be easier to say. However, some
words will probably maintain their negative or positive bias, no matter
what kind of day it is. Loaded words like "stuttering" may continue to be
stumbling blocks, even when things are going well.

CHANGING THE SCENARIO

-- His perceptions are shifted from negative to positive. Previously, he
felt unacknowledged; now he's been validated and feels the heady
confidence that goes with it.

-- His new self-perceptions affect his beliefs. Previously, he had no
confidence as a starving writer. Why should a beautiful woman go out
with him? What could he offer her? But as a writer whose skills have
been acknowledged, he now feels worthy. He's now somebody who has the
right to speak up and assert himself.

-- Positive perceptions and beliefs lead to positive emotions. And of
course, positive emotions lead to more upbeat perceptions and beliefs.

-- The negative intentions to hold back and hide that normally would have
kicked in when he was trying to say the word "Bob" are no longer
operating, because they don't fit with the new, positive Hexagon. The
name "Bob" now means something he's proud of.

-- Because he is no longer relying on Sally for acceptance--that is, because
he no longer needs her to make him whole--there's less riding on the
experience. Without the same feeling of impending disaster, Bob's
sympathetic nervous system does not push him into a fight-or-flight
response. He's not caught in a do-or-die scenario. Emotionally he remains
confident and collected, so he does not fall into the physiological response--
panic--that led to the previous crisis.

-- Within this positive system Bob no longer feels the need to hold back.
Quite the opposite, Bob wants to let go and share his good feelings with
everyone he meets. He expects a positive reaction, so he puts out positive
feelings which the young woman responds to, causing an even greater
surge of confidence.

Until experience brings about more lasting changes, the Hexagon will be
vulnerable to whatever life serves up--anything from the publication of a
book to the off-handed remark of a co-worker. And each change on the
Hexagon will be reflected in the individual's speech. In Bob's case, he's
probably not aware of why he's finding it easier to talk. All he knows is
that, speech-wise, he's having a good day.7

SOLVING SOME AGE-OLD RIDDLES

What I like about the Hexagon paradigm is that it provides credible
answers for virtually every question I've ever had about stuttering. Let's
look at several of the more common questions and see how the Hexagon
goes about answering them.

QUESTION: Why does chronic stuttering seem to run in families?
Doesn't this prove that it's genetic?

ANSWER: Not at all. What people don't take into account is that, not only
negative genes, but negative emotions, perceptions, beliefs and
psychological games are also passed along from one generation to another.
For example, it's not by accident that Dan Greenberg's book, How to Be A
Jewish Mother resonated with Jewish readers over different generations.
Attitudes, values and behaviors are good "time travellers" within cultures
and within families. When the components of the Stuttering Hexagon exist
within a family, it is only a matter of time until circumstances bring these
components together in the life of one individual in a way that causes them
go "critical" -- to borrow a term from nuclear physics. Once the
components organize themselves into a self-supporting system, you have
the first appearance of speech blocks.

QUESTION: Of the children who are disfluent at an early age, why do
most of them not develop a chronic stuttering problem?

ANSWER: Children who are disfluent at an early age are usually either
bobulating or struggling with developmental disfluency. It takes time to
build the emotions, perceptions, beliefs and psychological games that
comprise a chronic speech block. If the youngster is in a supportive
environment free of underlying stresses where pressures to perform do not
affect his speech, then the struggle and avoidance behaviors that lead to
blocking never take place. In other words, the Stuttering Hexagon is never
given an opportunity to form.

QUESTION: Why can someone talk to children without difficulty and
minutes later totally choke when asked to address an adult?

ANSWER: To explain this, let's create an example. Let's look at Jean, a
young woman who teaches kindergarten and see how she perceives herself
in two different situations.

In the classroom Jean clearly perceives herself as the boss, and her
emotions vis-a-vis the children are parental and supportive. Her word is
law, and with no one to challenge her knowledge or authority, her
intentions are always clear. Thus, there is no ambiguity around issues of
control. Nor does she ever feel judged, because there is no one in the
classroom who is capable of judging her. In this unthreatening environment
her beliefs about herself closely parallel what is true. Consequently, when
she goes to speak, there is no reason to hold back, and the words come out
easily and fluently.

But when the class ends and she goes to the teachers meeting where she
is scheduled to make an oral report, she moves into a radically different
environment, and this, in turn, initiates a dramatically different hexagon.

In meeting with her peers, Jean's beliefs about having to perform to
high standards now come into play. She perceives the others to be her
judges, especially the principal whom she sees as an authority figure. This,
in turn, elicits emotions such as fear and anger, feelings that she may not
only find difficult to express, but even to acknowledge. Sensing that others
may judge her, Jean is threatened, and her body/mind, not distinguishing
between physical and social threat, initiates the familiar genetic responses
associated with fight or flight.

In this threatening environment, her intentions become split. On one
hand she wants to give her report; on the other, she does not want to put
herself at risk. The ensuing approach-avoidance struggle becomes visible
in her halting and fragmented speech.

The previous example is not a universal explanation for why all people
do or don't block, but it does demonstrate how changes around the hexagon
can affect the individual in significant ways, and how such changes build a
reality that has a concomitant effect on the person's speech.

QUESTION: Why does chronic blocking and/or stalling sometimes
disappear or significantly reduce as people get older?

ANSWER: As people live out their lives, they continue to make
concurrent changes around the Stuttering Hexagon. Building personal
skills, rethinking values, establishing support systems, and broadening one's
perspective on life can create a Hexagon that supports honesty, self-love,
freedom of expression and letting go. This, in turn, can lead to greater
fluency.

The Hexagon also provides a foundation for the concept of Chronic
Perseverative Stuttering (CPS) Syndrome as advanced by Dr. Eugene B.
Cooper in a presentation at the 1986 convention of the American Speech-
Language-Hearing Association in Detroit.

Dr. Cooper describes CPS Syndrome as "an adolescent and adult
disorder in the fluency of speech resulting from multiple coexisting
physiological, psychological and environmental factors, distinguished by
(a) recurrence following periods of remission, (b) characteristic cognitive,
affective and behavioral response patterns and (c) susceptibility to
alleviation but, given the present state of the healing arts, not to
eradication."

The Stuttering Hexagon would explain CPS Syndrome this way. The
individual presenting CPS Syndrome is unwilling or incapable of making
all the necessary changes around the Hexagon needed to build a foundation
for total and lasting fluency. For example, the person may have emotions
that he may not be ready to deal with. He may be locked in relationships
that pressure him to perceive the world in a particular way. This, in turn,
makes him unwilling to challenge basic beliefs about himself. In such cases
speech therapy, by itself, will not be able to disable the system that supports
blocked speech, and there will always be a tendency to hold back.

What the Stuttering Hexagon can do is help to identify those areas where
improvement will have the greatest impact on his speech. Thus, if he
changes his perceptions in ways that allow him to reduce his level of stress
by 25%....and allows 25% more emotions to come through...and reduces
his need to be perfect by 25%...and becomes 25% more assertive...and
reduces his self-defeating games by 25%...and if he combines this with
fluency training, then he is able to develop a Hexagon that is 25% more
supportive of fluent speech. True, his speech won't in all likelihood be
completely fluent, but it may attain a level that serves his needs.

In short, the Stuttering Hexagon can show where his areas of weakness
lie. And it can broaden the focus of both therapist and client, so they don't
become obsessively focused on speech to the exclusion of those other
factors that need to be addressed.

SOME PROBLEMS CANNOT BE SOLVED

A word about "cures." We keep thinking that we can solve stuttering as
if it were some kind of math problem. True, you can seem to make a
behavior disappear by focusing on not doing it, as is suggested in fluency
shaping programs. But unless you carry this process one step further to
where you also dissolve the "glue" that holds the stuttering system together,
the behavior will almost always return.

Why?

The great irony is that the harder you try to solve a stuttering problem,
the more you reinforce its presence, because in order to have something to
solve, you must continually recreate it.

Does that mean that problems can't be solved? Not at all. You can
figure out that tricky algebra problem. You can come up with a solution
on how to reorganize the corporation or where to vacation next year.
That's because you're not trying to make the algebra problem, the
corporation or your vacation disappear. But when you want something to
disappear, such as stuttering, you have to take a different approach. To
"disappear" something you don't solve it. You dissolve it. This is not just
playing with words; there is a world of difference between the two
approaches.

When you solve a problem, the subject continues to exist, although its
form may be altered or disguised. On the other hand, when you dissolve
it, the subject disappears because you have dismantled it (rather like you
did as a child when you took apart the car you made with your Leggo set
and put the parts back in the box.) You have disconnected the parts so they
no longer interact. You have removed the problem by destroying its
structure.

Let's say that 10-year-olds Tom, Dick and Harry comprise an unruly
gang whose activities you'd like to curtail. If you deal with them as a gang,
you may only enjoy limited success, because the more you address the gang
directly, the more you confirm its identity. But if you induce the three
boys to join a youth group and assign each of them to a different activity,
the gang becomes dissolved into a larger setting. The structure that defines
their gang no longer prevails, because the "parts" have become
disassembled and incorporated into other structures. In effect, the gang
and your problems have all but disappeared.

Similarly, focusing on chronic stuttering (which, unfortunately, many
therapy programs do) only serves to entrench it within the individual's
psyche, whereas disassembling it into a six-sided system not only destroys
its form but automatically gives you six issues to address instead of one.
From my own experience, it was a lot more productive to stop obsessing
on my speech and focus on the six parts of the stuttering system.

THE ROLE OF THE SPEECH-LANGUAGE PATHOLOGIST

What of the role of the therapist in this new paradigm? Does it need to
change?

A while back, I conducted several seminars on the Stuttering Hexagon at
the Tenth Annual Convention of the National Stuttering Project, held in
Washington D.C. On the way to the airport a fellow who had attended one
of my workshops popped a familiar question: "Isn't it unrealistic to expect
the speech therapist to play so many different roles." It is a question that
has been echoed by Dr. Don Mowrer of Arizona State University in our
discussions over the Internet.

As Mowrer points out, it is unlikely that the speech-language pathologist
would also be a psychologist as well as be qualified to teach assertiveness
and a full range of cognitive and behavioral skills. But then, neither do I
expect my internist to be a qualified podiatrist, urologist, cardiologist,
dermatologist and every other "ist" that I might need. My internist is most
valuable as a skilled diagnostician. He may have a specialty of his own, but
he is most invaluable in his understanding of how my system goes together.

Similarly, a good speech therapist needs to be an expert in speech
pathology as well as be able to recognize the other factors that may be
impacting the client's speech. Then, just like my internist, the therapist
should be able to diagnose the problem and, if he or she does not have the
requisite skills, be prepared to direct the client to the appropriate
therapeutic resources when such qualified help is called for. But to do this,
the therapist must possess an understanding of the entire stuttering system
and not focus so narrowly on just the mechanics of speech.

SUMMARY

For years people have searched for the genetic "glitch" that produces the
stuttering block. What I'm proposing is that the speech block, is actually
the product of an interactive system comprising a person's physiological
responses, behaviors, emotions, perceptions, beliefs and intentions. This
system is not static; rather it is a system that ebbs and flows, depending on
the circumstances. And it works along the following lines:

All the system components of the Hexagon are in a dynamic
relationship. If most of these elements are negative, they will create
more negativity. Thus, even if one part of the system has become
positive, such as speech that has improved after therapy, it will be
under pressure by the rest of the system to drift back to its previous
negative state to support the integrity of a negative system. On the
other hand, if the points of the Hexagon are mostly positive, they'll
create a positive system that will support any positive changes such as
more expressive and fluent speech.

During good speech periods, the Hexagon will be positively biased and
support a state of physical and emotional well-being. Conversely, a
failed enterprise, broken relationship or other unfortunate
happenstance can cause negative changes all around the Hexagon, and
those changes will be reflected in more dysfluent speech.

Each individual word is capable of having its own Hexagon, depending
on what we associate with it and the context in which it is being used.
If a person is uncomfortable with the negative feelings associated with
a particular word, he may hold them back, blocking on the word to
insulate himself from having to experience the associated feelings.

As we speak, the mind operates like a forward-looking radar. It
searches ahead for threatening words and situations, processes this
information in milliseconds on a word-by-word basis, and takes
"corrective" action in the form of a speech block. On a pre-conscious
level, the speech block is perceived as necessary to protect the
individual from harm -- emotional, physical, or social.

Certain situations may always seem to be biased one way or the other.
For example, to understand why someone may regularly have
difficulty saying his name, we must look at his perceptions, beliefs,
emotions and intentions as they relate to his name.

One effective way to block feelings is to block the primary vehicle
through which emotion is expressed -- speech. Holding one's breath
and/or tightening speech-related muscles is an efficient way to bring
about a speech block.

Executing a Valsalva Maneuver while trying to speak will also cause a
blockage of speech.

Stalling is yet another way to avoid experiencing unwanted feelings.
Stalling occurs when the person continues to repeat a word or syllable
because he has a fear that he will block on the following word or
syllable.

Developmental disfluency, bobulating and blocking/stalling are all
driven by different dynamics. They are not simply points on the same
continuum. Thus, they require separate terminology.

Making positive life changes will affect one's life Hexagon in a
positive way. These changes will often be reflected in easier, more
expressive speech.

The more points you change around the Hexagon, the greater chance
you have to build a positive, self-sustaining system that leads to greater
expressiveness and fluency.

Like the remote-controlled toy car we mentioned earlier, the speech
block has always been perceived as a "thing", an impetuous, unpredictable
life-form with a mind of its own. My own recovery from chronic
stuttering truly took hold when I challenged this concept, when I "popped
the hood", peered inside, and began to recognize that I was looking at a
system. My physiology shaped the parts. My emotions fueled the engine.
My beliefs turned the gears. My programming wired the parts together.
My perceptions set the path. And my behaviors drove it to move this way
and that.

As I identified the parts and how they worked, my perception of the
speech block changed, and as I made progress at each of the points, the
system changed, until over time, the stuttering simply dissolved.

I don't suggest for a moment that everyone can make their speech
blocks totally disappear, but by correctly recognizing the essential nature
of the problem, it is possible to maximize whatever efforts are made in
improving one's ability to speak.

Copies of this paper (with better looking diagrams and page layout) are
available for $3.00 (within the U.S.) or $4.00 (outside North America) to
cover duplicating and postage from John C. Harrison, 3748 22nd Street,
San Francisco, CA 94114, USA. Your comments, questions, ideas and
suggestions are invited